The Young Buddhists Association of Thailand
and the House of Dhamma

Insight Meditation Retreat Application Form

Date of retreat

Mr/Mrs/Miss Name
Surname

Permanent address

tel
email address

Temporary address in Thailand

tel.

Date of birth
nationality

Passport or ID number
Occupation

Name and address of a person to contact in emergency


Have you practised Vipassana meditation before? yes no

How long have you practised?

Have you practised other forms of meditation? yes no

If so please give details

There is a charge of 3,000 baht per person for weekend retreats for running expenses and utilities. For 7-day retreats, the charge is 5,000 baht. There is no extra charge for optional workshops.
Donations will be used to enable the teachers to continue Dhamma work.

I agree to abide by the rules of the meditation retreat.

Yes No

Please send e-mail at least 7 days before the first day of the retreat.